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A New Criterion for Pediatric AKI Based on the Reference Change Value of Serum Creatinine. Xu Xin,Nie Sheng,Zhang Aihua,Jianhua Mao,Liu Hai-Peng,Xia Huimin,Xu Hong,Liu Zhangsuo,Feng Shipin,Zhou Wei,Liu Xuemei,Yang Yonghong,Tao Yuhong,Feng Yunlin,Chen Chunbo,Wang Mo,Zha Yan,Feng Jian-Hua,Li Qingchu,Ge Shuwang,Chen Jianghua,He Yongcheng,Teng Siyuan,Hao Chuanming,Liu Bi-Cheng,Tang Ying,Wang Li-Jun,Qi Jin-Lei,He Wenjuan,He Pinghong,Liu Youhua,Hou Fan Fan Journal of the American Society of Nephrology : JASN BACKGROUND:Current definitions of AKI do not take into account serum creatinine's high variability in children. METHODS:We analyzed data from 156,075 hospitalized children with at least two creatinine tests within 30 days. We estimated reference change value (RCV) of creatinine on the basis of age and initial creatinine level in children without kidney disease or known AKI risk, and we used these data to develop a model for detecting pediatric AKI on the basis of RCV of creatinine. We defined pediatric AKI according to pediatric reference change value optimized for AKI in children (pROCK) as creatinine increase beyond RCV of creatinine, which was estimated as the greater of 20 mol/L or 30% of the initial creatinine level. RESULTS:Of 102,817 children with at least two serum creatinine tests within 7 days, 5432 (5.3%) had AKI as defined by pROCK compared with 15,647 (15.2%) and 10,446 (10.2%) as defined by pediatric RIFLE (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO), respectively. Children with pROCK-defined AKI had significantly increased risk of death (hazard ratio, 3.56; 95% confidence interval, 3.15 to 4.04) compared with those without AKI. About 66% of patients with pRIFLE-defined AKI and 51% of patients with KDIGO-defined AKI, mostly children with initial creatinine level of <30 mol/L, were reclassified as non-AKI by pROCK, and mortality risk in these children was comparable with risk in those without AKI by all definitions. CONCLUSIONS:pROCK criterion improves detection of "true" AKI in children compared with earlier definitions that may lead to pediatric AKI overdiagnosis. 10.1681/ASN.2018010090
A novel strategy for identifying early acute kidney injury in pediatric hematopoietic stem cell transplantation. Benoit Stefanie W,Dixon Bradley P,Goldstein Stuart L,Bennett Michael R,Lane Adam,Lounder Dana T,Rotz Seth J,Gloude Nicholas J,Lake Kelly E,Litts Bridget,Davies Stella M Bone marrow transplantation Acute kidney injury (AKI) is a common complication in pediatric hematopoietic stem cell transplantation (HSCT). Serum creatinine is an imprecise biomarker of AKI. We hypothesized that combining creatinine with serum cystatin C (cysC) and urinary neutrophil gelatinase-associated lipocalin (NGAL) more effectively characterizes AKI during the first 28 days of HSCT and better identifies patients at risk of adverse outcomes than creatinine alone. We prospectively assessed the type and severity of AKI in 80 consecutive allogeneic HSCT patients using weekly creatinine, cysC, and NGAL. We combined the biomarkers to define 7 Composite Types of AKI, including All Positive AKI (simultaneously detected creatinine, cysC, and NGAL AKI). Outcomes included renal replacement therapy and transplant-related mortality. In all, 75% of patients had AKI by at least one measure; 33% developed >1 type of AKI. Mild AKI often preceded Severe AKI. Patients with creatinine or NGAL AKI that were Severe or Repeated tended to have worse outcomes. The five patients with All Positive AKI had the highest rates of morbidity and mortality. AKI evaluation with creatinine, cysC, and NGAL provides a comprehensive profile of early AKI and narrowly identifies patients at highest risk of adverse outcomes, providing opportunities for early, impactful intervention. 10.1038/s41409-018-0428-6
Markers of acute kidney injury in children undergoing hematopoietic stem cell transplantation. Augustynowicz Monika,Bargenda-Lange Agnieszka,Kałwak Krzysztof,Zwolińska Danuta,Musiał Kinga Advances in clinical and experimental medicine : official organ Wroclaw Medical University Acute kidney injury (AKI), one of the major complications in children undergoing hematopoietic stem cell transplantation (HSCT), is an independent predictor of the patient's survival and a prognostic factor of progression to chronic kidney disease (CKD). Despite the multifaceted role of AKI, its early diagnosis in the course of HSCT remains a challenge. These difficulties may result from the inefficiency of traditional methods used to assess kidney function, like serum creatinine or estimated glomerular filtration rate. Moreover, the list of potential AKI markers tested in HSCT conditions is limited and does not involve indexes evaluated in the pediatric population. This review summarizes current knowledge on the pathophysiology of AKI developing in the course of HSCT; presents well-known markers of AKI that are potentially applicable in children who have undergone HSCT; discusses the role of new markers in diagnosing AKI and predicting the renal outcome in children undergoing HSCT; and analyzes the prospects for the use of new tools for assessing kidney injury in everyday clinical practice. 10.17219/acem/101573